Meeting Patients Where They Are: Construction And Maintenance Of Analytic Intimacy

Abstract

This paper aims to describe the processes of construction and maintenance of analytic intimacy, understood as a shared state of relative internal freedom that is most permeable to preconscious and unconscious communications, which facilitate the processes of subjectivation, dreaming, and digestion of unprocessed trauma. The author illustrates the theoretical and technical features related to the concept of intimacy, highlighting the transformations of a clinical case followed in supervision. This article is presented in the form of a conversation with the supervisee, so as to evoke in the reader the dialogic and co-constructive experience of thought construction.

Keywords:

• Intimacy
• setting
• analyzability
• supervision
• conversation
• emotional tuning
• online
• modesty
• interpsychic
• intersubjectivity

Notes

1 Thought, when it becomes dialogue, unravels, acquires breath and new vertices of observation. Beginning with Plato’s Socratic Dialogues, running through Freud’s letters to Fliess and his constant addressing, in essays, of supposed opponents, or interlocutors. I would cite Bion’s Clinical Seminars (1994) and the Memoirs of the Future trilogy (1975) or Ogden’s recent dialogue with the masters of psychoanalysis (2012). Today, the in-between character of meaning, strongly relational and intersubjective, has led several colleagues to structure scholarly work as an interview or conversation (Ogden & Di Donna 2013; Ferro & Nicoli 2017; Lütz & Kernberg 2020).

This work takes its cue from a long ongoing supervision I have with a brilliant colleague, whom I will leave anonymous to further protect the confidentiality of the patient we will discuss. The colleague’s curiosity, questions, and perplexities allowed me to refine and clarify several times, with him and within myself, assumptions about the construction and maintenance of analytic intimacy. Therefore, I wanted to reproduce in the text the dialogical character of thought, giving life to the character of Kappa, who represents a kind of intersubjective third party that emerged in the course of our work on intimacy.

I want to emphasize that this narrative device has argumentative value, and is not meant to be an example of supervision.

2 I play on the sign equivalence between O and 0 (zero) to emphasize how Kappa has to give up his sense of knowledge (K is short for Knowledge, in Bion’s conceptualization) and feeling lost (being a zero), in order to becoming the other, in the sense of being as close as possible to the other’s emotional experience.

Additional information

Notes on contributors

Luca Nicoli

Luca Nicoli, psychologist and psychoanalysts, is member of the Italian Psychoanalytic Society and International Psychoanalytical Association. Together with Antonino Ferro, he is author of The Young Analyst’s Guide to the Galaxy (Karnac, 2017).